Your physician may be thinking about suicide

by Heather Fork, MD

Very few of us are untouched by the tragedy of suicide. Whether in our own family, through friends, or one of our colleagues, most of us have been affected by suicide.   We are often left alone, with the painful questions,

“Why?”

“What could we have done differently?”

Now we learn from a study by Shanafelt et. al, in the Achieves of Surgery, that one in 16 surgeons had suicidal ideations in the previous year. Yet only 26% of these surgeons sought psychiatric or psychological help. That so many of those who needed help did not seek it brings a disturbing issue to light:

Doctors are concerned that seeking mental health treatment could adversely affect their medical license.  In the study, 60% of the surgeons were reluctant to seek help due to this very reason.

Surgeons who felt burned out, or reported they’d made a “major medical error” in the past 3 months, were more prone to suicidal thoughts.

Ironically, physician health may be compromised in the service of helping others to obtain better health.

According to the American Foundation for Suicide Prevention (AFSP), “Physicians die by suicide more frequently than others of their gender and age, both in the general population and other professional occupations.  On the average, death by suicide is about 70% more likely among male physicians than other professionals, and 250% to 400% higher among female physicians.”

Every year, we lose the equivalent of at least two medical school classes due to physician suicide (nearly 400 doctors, according to estimates).

How do we remove the stigma around getting help?  How do we lessen the burnout? How do we remove the fears related to licensure?

I am heartened by a variety of positive measures being taken to address these issues:

1. After several suicides occurred at Vanderbilt Medical Center, a Faculty and Physician Wellness Program was established.

2. The University of California at San Diego Medical Center instituted a Suicide Prevention-Depression Awareness Program following a series of suicides.

3. The Mayo Clinic created a Program on Physician Well-Being, which combines research, education, and the development of wellness promotion programs.

4. The Liaison Committee for Medical Education recently mandated that medical schools provide a wellness program for students; a change that came about due to recent investigations of medical student distress.

5. Researchers and physicians from around the world are collaborating to promote physician wellness.  A biennial conference on physician health brings together members from the American, Canadian and British Medical Associations.

6. The Arkansas Medical Board changed the wording on their licensure application after several suicides occurred.

7. An interventional study was conducted by Krasner and colleagues to determine the effect of a mindfulness-based program on physician well-being, burnout, and empathy towards patients. The results showed short and long-term improvement in physician well-being and attitudes associated with patient-centered care.

8. Dr. Patricia Lindholm, president of the Minnesota Medical Association has made physician wellness a top priority for her tenure.

The good news is that there is insufficient space to mention all the commendable efforts already in existence to improve physician health.

However, the work has only just begun.

If you want to heed the call to action, you can make a difference. By reaching out to a colleague in distress, supporting a wellness program, or working to reducing the stigma of mental heath issues, you may save a colleague’s life.

Heather Fork is founder and coach at the Doctor’s Crossing.

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  • ruben cooper

    It is not just stress that accounts for this but there is the inherent similarities in people who become doctors. Not just the drive to succeed which is obvious, but there is also a need to provide everything for others, to be perfect in one aspect of one’s dealings. Of course, this is not possible. It has been observed that many doctor suicides occur when there is a malpractice suit, where one’s perfection, couched in competence, is questioned. When there is a problem with one’s sense of self esteem, noted to be ‘narcissism’, it can go two ways; the person can be become a narcissist, someone with little empathy and tendency to be controlling and aggressive, or the person can turn the aggression inwards and be depressed. If you think that doctors are not prone to either one, think again. Pathological narcissism is common in doctors. Typically, doctors are not very nice to each other, contrary to popular belief. It’s not a good old boy network as many might think.
    This subject came up on one of the physician only social sites, Sermo, and I was astonished to see some of the most vicious posts against doctors who thought about suicide.
    There is the old adage, Physician, heal thyself. Many doctors think it’s the only way because physicians are not very sympathetic to each other. That is the sad part about it, the reluctance to seek out care from others.

    • http://www.doctorscrossing.com Heather Fork

      Thank you Ruben Cooper for your great reply. You raise some excellent points about the risk factor of personality type, with the perfectionism common to physicians being a double-edged sword, and how doctors can be less than compassionate towards each other. Dr. Patricia Lindholm, who is mentioned above (#8), has created her own version of the adage you brought up, “Physician Heal Thyself. She adds, “Physician Love Thyself. Physician Love Thy Colleague.” If you want to see her address to the Minnesota Medical Association where she
      makes this statement, it is only 2 minutes and can be found here: http://doctorscrossing.com/tag/dr-patricia-lindholm/.

  • Anon

    I wish there were more comments on this topic. This is going to sound overly idealistic, but if it makes anyone feel better who might be reading this, I don’t care. One source of, maybe not help, but comfort, for physicians who are considering suicide, may be found in the vast majority of your patients. No, we’re not in a position to counsel you or solve your problems, but most of us do offer the small human kindnesses and appreciation for your hard work that are drowned out/ignored when malpractice cases take center stage. Most patients will forgive you if you make a mistake, sometimes even a huge mistake, as long as the mistake wasn’t made because you didn’t care. We understand you get tired and have bad days just like us. We know you can’t be perfect. We expect you to be good at what you do, not perfect, and we expect you to care as best you can.

    Some patients DON’T understand the time constraints you’re under, or how your office works, but most would happily cooperate if given this information in a kind way.

    Maybe this doesn’t make sense – as patients, there’s not much we can do for you, but we are human and we can be compassionate as well.

    • http://www.doctorscrossing.com Heather Fork

      Thank you Anon, for sharing this lovely perspective, and what you wrote made complete sense. I found it very touching and a good reminder that yes, many patients are very appreciative, and they will be forgiving of mistakes when they know their doctor is just trying to do his or her best. There is a trend towards more open disclosure and better communication with patients and families when a mistake is made, and this is showing to have many benefits. Thank you again, for expressing your compassion, it is significant and does make a difference.

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